21368 - Laserfiche WebLink

Home Browse Search

----------------------_......._------------- i _____________________-___.._- ----- ------ APPLICATION FOR SANITATION PERMIT Permit No. �_1 3......... (Complete in Duplicate) -------------- This Permit Expires I Year From Date Issued Date Issued 4-1a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I j 1-->T 1= - - r!a a 1`" JOB ADDRESS AND LOCATION/ '117 - TN_ ----------- -------- .T - l �^ -T , Owner's Name -t----- !--•-•----C��-PNC �--------- I T-()-N-------------------------- -------- ----- ------- Phone------------------------------------ Lr I K �7,rT Address-------------------•-- ---� r 7 I F' Contractor's Name__�NTHj2N V _. -----------�7 l)F_._T 0 Phone------------------------•-------- Installation will serve: Residence/2' Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ -� � r Number of living units: __�____ Number of bedrooms _- Number of baths __/-__ Lot size ____15_-aa --- ___-___`------_----------- Water Supply: Public system ❑ Community system ❑ Private 0- Depth to Water Table J0_ ft. Character of soil to a depth of 3 feet: Sand 0` Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------_--------____) No Q` New Construction: Yes ❑ No ®' FHA/VA: Yes ❑ No D- TYPE OF INSTALLATION AND SPECIFICATIONS: (No seffc tank or cesspool permitted if public sewer is available within 200 feet.) f Septic T k: Distance from nearest well-----5- _-Distance from foundation---/ ---------Material... --_______- No. of compartments____- -2--------------Size__3__x_9..Y57___Liquid depth----�,��_ ----____CapacitY____,�__ Disposal Field: Distance from nearest well.__SP.-----Distance from foundation----/0---------Distance to nearest lot line__:�_____ ❑' Number of lines---------+t--------- -------------Length of each line-------Z[r_ ------Width of trench......-36--if----------------- rc Type of filter material---RP6_eS.....Depth of filter material------17__--------Total length_____________________62 Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line__.______---_-__. ❑ Number of pits--------------- ----Lining material--------_--------------Size: Diameter-----------------------Depth.......------------------------__ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_..._---_--________.____..____-____. ❑ Size: Diameter----- - ------------------------------Depth---------- -----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------_-__Distance from nearest building---------------------------------- ---- ❑ Distance to nearest lot line------------- - ------------------------------------------------------ Remodeling and/or re airing (escribe):---------am-F POII.-_---__F__ ---___ � i .._-___ �' ------- ----- -- --------- ---- -------- ------------------ ------ ------------------------------------ --------------------------------------------------------------------------------------------------------------- --------Tt-F,P------------------------------------------------ ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepay d.this application and that the work will be done in accordance with San Joaquin County ordinances, Ste a law', nd rules and regulations o the San.Joaqui ocal Health District. J (Signed) ' � � Ll�` C C?------------------------------(Owner and/or Contractor) By:------------ ------------��%i_� 1 _' ---- ------------------------ C 0---'-----------------(Title)-------------------------------------------..- ---- --------- (Plot plan, showing size of lot, location of sysfkm in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -O ------------- ------------------------------------------- DATE------ '= - �' REVIEWEDBY-------------------------------- ----------- --------------------- - ------------------------------------------------------- DATE------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------- Alterations and/or recommendations-------- ------------------------ ----------------------------------------------------------------------•------------------- ------------------------------------------------------------------------ ----------- ----------------------------------------------------------------•-••----------------------------------------------------•--------------- ---------------- - ----------- ------------------------- . ? - -------------------- ------------------------------------------ ------------------------------------- ------------------------- ------------ , 4 - ----------- FINAL iNSPECTION_B L: � I7 �fl�--- ---- ----- - -- Date_-_-- -� - --- ---�` _ ........ JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.